Healthcare Provider Details

I. General information

NPI: 1629416805
Provider Name (Legal Business Name): BAPTIST CARDIOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 VILLAGE SQUARE PKWY STE 204
FLEMING ISLAND FL
32003-6409
US

IV. Provider business mailing address

PO BOX 746652
ATLANTA GA
30374-6652
US

V. Phone/Fax

Practice location:
  • Phone: 904-224-5185
  • Fax: 904-376-3202
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-376-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TYRONE STEWART
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 904-720-0799